腰椎间盘突出症传统开窗手术治疗的前瞻性研究

Prospective study of traditional open surgery for treatment of lumbar intervertebral disc herniation

目的 探讨腰椎间盘突出症的外科治疗方法.方法 采用前瞻性研究的方法,以我院骨科收治的2007年6月至2009年10月术前确诊为腰椎间盘突出症的103例患者,行传统开窗手术治疗,手术疗效按照RDQ功能障碍评分（Roland-morris指数）、腰痛JOA评分及VAS疼痛评分标准进行评定.结果 所有病例均顺利完成手术,手术后患者随访8～24个月（平均15.3个月）,RDQ评分由术前的（19.4±1.7）分改善为末次随访时的（9.1±1.8）分;腰痛JOA评分由术前的（9.1±1.4）分改善为末次随访时的（25.6±1.4）分.术前与末次随访时相比两个评分均有大幅改善,差异有统计学意义（P＜0.05）.VAS疼痛主观评分术前与末次随访时也有明显改善.结论 采用传统的开窗式椎间盘切除术,患者经济负担轻,术后和短期随访的效果均达到满意程度.传统的开窗式椎间盘切除术仍应是治疗腰椎间盘突出症的主要术式.

Objective To investigate the surgical treatment of lumbar disc herniation （LDH）led by lumbar intervertebral disc degeneration and discuss the routine surgical therapy for LDH. Methods In this prospective study, a total of 103 patients were preoperatively diagnosed as LDH from June 2007 to October 2009 in our department, all of them received open surgical operation. The RolandMorris Disability Questionnaire （RDQ）score, JOA low back pain score, and visual analogue scale （VAS）pain score were employed to measure the clinical outcomes. Results All the operations were performed successfully and all the patients were followed up for 8 month to 24 month（ mean 15.3 months）. After the surgical treatment, the average RDQ score was improved from（9.1 ±1.8 ） to （ 19.4 ± 1.7 ） ; The average JOA low back pain score was improved from （ 9.1 ± 1.4 ） to （ 25.6 ± 1.4 ） ; Both these scores were improved obviously and there was a significant difference between them （ P 〈 0.05 ）. The VAS was also improved significantly. Conclusion The traditional open surgery of LDH could be satisfactory in both economics of patients and the clinical outcomes. It remains the first choice for the treatment of LDH.